| NPI | 1902349020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95007653) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 792153) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2018-08-02 |