NPI | 1639410699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 23102) |
Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 797382) |
Enumeration Date | 2013-03-14 |
Last Update Date | 2013-10-14 |