NPI | 1699248716 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011305) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 761150) |
Enumeration Date | 2019-01-11 |
Last Update Date | 2019-03-12 |