| NPI | 1235374596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 18480) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CA 3043) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2008-12-15 |