| NPI | 1932425303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 22938) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 746599) |
| Enumeration Date | 2010-04-10 |
| Last Update Date | 2022-07-21 |