| NPI | 1821406554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 806451) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001034) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2023-07-27 |