| NPI | 1861411324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 15088) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 538312) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 15088) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2009-07-20 |