NPI | 1356068878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95022468) |
Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: CA 95022468) |
163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CA 95022468) | |
Enumeration Date | 2022-10-25 |
Last Update Date | 2022-10-25 |