| NPI | 1720272065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 21727) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 640935) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2012-05-18 |