| NPI | 1942740899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95006058) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 819828) |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2017-02-27 |