| NPI | 1275550709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 9393) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA RN421408) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-12-04 |