NPI | 1437499704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 22648) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 714667) |
Enumeration Date | 2013-02-25 |
Last Update Date | 2015-12-30 |