| NPI | 1487168456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA F03170624) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA F03170624) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2019-08-26 |