| NPI | 1205086717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 18562) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 607725) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2020-10-07 |