NPI | 1699241265 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95000039) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95000039) |
Enumeration Date | 2018-10-22 |
Last Update Date | 2021-09-20 |