| NPI | 1821563073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95010238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95051033) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2018-10-15 |