| NPI | 1184757791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 11779) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9190363) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-05-22 |