| NPI | 1922279272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NPF17762) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP17762) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2014-06-09 |