| NPI | 1639410699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 23102) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 797382) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2013-10-14 |