| NPI | 1326091018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN429346) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA np8501) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |