| NPI | 1386876712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 4991) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 4991) |
| 363L00000X Nurse Practitioner (Licence: CA 95005461) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95005461) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 7452) | |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2021-02-02 |