NPI | 1952729014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000517) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 731539) |
Enumeration Date | 2014-04-04 |
Last Update Date | 2014-05-23 |