NPI | 1881240091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95034725) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95191190) |
Enumeration Date | 2019-08-13 |
Last Update Date | 2025-05-21 |