NPI | 1790107670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 812590) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000284) |
Enumeration Date | 2014-01-13 |
Last Update Date | 2014-03-10 |