| NPI | 1104109750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 21296) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 529326) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2014-01-30 |