| NPI | 1225261027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 13148) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 513743) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2012-10-25 |