| NPI | 1154421873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 16859) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP699679) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2021-04-28 |