| NPI | 1437359072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 17050) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 389692) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2011-11-29 |