NPI | 1780283143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95015593) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 765153) |
Enumeration Date | 2020-10-17 |
Last Update Date | 2020-10-17 |