| NPI | 1669612834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 19317) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 553428) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2021-08-20 |