NPI | 1982342325 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023495) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95041252) |
Enumeration Date | 2022-05-25 |
Last Update Date | 2023-02-14 |