| NPI | 1669732103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 5798) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 778908) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95000831) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2018-09-13 |