NPI | 1619417060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95005970) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95055588) |
363LF0000X Nurse Practitioner, Family (Licence: CA 95005970) | |
Enumeration Date | 2017-03-05 |
Last Update Date | 2020-06-30 |