| NPI | 1275931529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA F1214088) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 624771) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 950000516) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-18 |