| NPI | 1093082885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95002124) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60243614) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2022-01-05 |