| NPI | 1457807208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95004994) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CA 728571) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2019-12-24 |