| NPI | 1215282785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 21689) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 766206) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-11-19 |