| NPI | 1245575315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 001840) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 726633) |
| 163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: CA 726633) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 22618) | |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2024-06-26 |