| NPI | 1841292869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 813415) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA RN495203 NP9973) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2019-01-29 |