| NPI | 1124335807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 19774) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 624546) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-12-07 |