| NPI | 1841530185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 22825) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 001443) |
| Enumeration Date | 2013-02-24 |
| Last Update Date | 2014-07-02 |