| NPI | 1003394537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011032) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 8555-33) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2019-02-06 |