| NPI | 1922427665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000312) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 812700) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2014-04-09 |