| NPI | 1114323029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95025742) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA 86065943) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2023-07-05 |