| NPI | 1700141470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 22149) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN122867) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2014-09-17 |