| NPI | 1265783880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP23190) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60314068) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2013-11-14 |