NPI | 1679690044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WM0705X Registered Nurse Medical-Surgical (Licence: CA RN351454) |
Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: CA NPF10167) |
Enumeration Date | 2007-03-23 |
Last Update Date | 2007-07-08 |