| NPI | 1760598130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC1500X Nurse Practitioner Community Health (Licence: CA RN500867) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: CA RN500867) |
| 363LF0000X Nurse Practitioner Family (Licence: CA NP11538) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-03-07 |