| NPI | 1124231758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95007362) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-0272190) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2018-08-03 |