NPI | 1689312100 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022427) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95180692) |
Enumeration Date | 2022-05-24 |
Last Update Date | 2022-08-31 |