| NPI | 1952729014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000517) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 731539) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2014-05-23 |