NPI | 1336411974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 21029) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 753418) |
Enumeration Date | 2012-01-28 |
Last Update Date | 2012-01-28 |