NPI | 1497166961 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001900) |
Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: CA NPF95001900) |
363LA2100X Nurse Practitioner, Acute Care (Licence: CA NPF95001900) | |
Enumeration Date | 2014-05-18 |
Last Update Date | 2019-04-18 |