| NPI | 1700141322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP22256) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA RN818786) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2013-04-19 |