NPI | 1306365390 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 8622) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 457877) |
Enumeration Date | 2017-09-12 |
Last Update Date | 2017-09-12 |