| NPI | 1760670616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 22045) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 641128) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2014-11-19 |