| NPI | 1376836981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201394165NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP 20561) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2017-12-02 |