| NPI | 1073160768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012999) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 95202017) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2020-03-01 |