| NPI | 1225201353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 17958) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 17958) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2015-11-25 |