NPI | 1497126197 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012110) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95068057) |
Enumeration Date | 2015-10-07 |
Last Update Date | 2020-10-22 |