| NPI | 1124562939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95006004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN95078148) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2017-08-25 |