| NPI | 1013077841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF95028041) |
| Additional Taxonomies | 111NR0400X (Licence: CA 29727) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-11-27 |