| NPI | 1871599548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP9406) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA RN 495518) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA NP 9406) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2015-04-22 |