| NPI | 1700065802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 17778) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 167214) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2009-07-14 |