| NPI | 1164657300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APN001116) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 95000883) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2022-08-09 |