| NPI | 1750612388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP19460) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 528243) |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2022-05-27 |