| NPI | 1194812743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 4202774) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA RN202774) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2013-01-24 |