| NPI | 1184989246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012035668) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 184418) |
| 163W00000X Registered Nurse (Licence: CA 820337) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2014-01-22 |