| NPI | 1538281225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001936) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 763379) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2024-05-29 |