| NPI | 1083015887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95006240) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN170793) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2018-03-17 |