NPI | 1861019564 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95018432) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95137162) |
Enumeration Date | 2020-06-29 |
Last Update Date | 2022-01-13 |