NPI | 1912367814 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 800956) |
Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P31593) |
163W00000X Registered Nurse (Licence: CA 800956) | |
363L00000X Nurse Practitioner (Licence: CA 95020099) | |
Enumeration Date | 2016-03-04 |
Last Update Date | 2022-02-25 |