NPI | 1861992141 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95009004) |
Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: IL 20120540) |
Enumeration Date | 2018-02-13 |
Last Update Date | 2019-11-19 |