| NPI | 1750521936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11031031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 635506) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95003311) | |
| 163W00000X Registered Nurse (Licence: FL 9650991) | |
| Enumeration Date | 2009-02-27 |
| Last Update Date | 2024-07-22 |