NPI | 1780121582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006950) |
Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: CA 86958) |
163W00000X Registered Nurse (Licence: CA 740595) | |
Enumeration Date | 2017-01-31 |
Last Update Date | 2021-11-02 |