| NPI | 1558506865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003703) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: CA 523801) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2018-08-16 |