NPI | 1730550112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95005951) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95053130) |
Enumeration Date | 2015-10-12 |
Last Update Date | 2020-05-08 |