| NPI | 1437499704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CA 22648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 714667) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2015-12-30 |