| NPI | 1265440473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 097007040N1 FNPPP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 6696) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-05-30 |