NPI | 1891841375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 3976) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA#12407) |
Enumeration Date | 2007-01-26 |
Last Update Date | 2011-08-10 |