| NPI | 1417148073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP3345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN330400) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2011-11-17 |