| NPI | 1689797029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 7662) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 349096) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-04-02 |