| NPI | 1821331174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95003671) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 833793) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2016-03-27 |