NPI | 1386983583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 22856) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 579376) |
Enumeration Date | 2013-02-07 |
Last Update Date | 2022-01-03 |