| NPI | 1124387568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004432) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1116552) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201509529NP-PP) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2016-08-31 |