| NPI | 1710296116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 19644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 732729) |
| Enumeration Date | 2010-10-02 |
| Last Update Date | 2010-10-02 |