| NPI | 1326573759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 826029) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-12-07 |