| NPI | 1003165135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 22074) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 593398) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2022-10-27 |