| NPI | 1851327886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7483839-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP15320) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2011-01-14 |