| NPI | 1164432969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 9868) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 486848) |
| 363L00000X Nurse Practitioner (Licence: CA 9868) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2024-01-22 |