| NPI | 1487617064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP17933) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71000749A) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3102) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2010-04-08 |