NPI | 1558836999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95009813) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA NP95009813) |
Enumeration Date | 2018-10-12 |
Last Update Date | 2019-12-05 |