| NPI | 1184045825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95000208) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 657249) |
| Enumeration Date | 2013-12-25 |
| Last Update Date | 2016-07-14 |