| NPI | 1235572728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 22487) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 775296) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-15 |