NPI | 1821563073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010238) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95051033) |
Enumeration Date | 2018-10-03 |
Last Update Date | 2018-10-15 |