| NPI | 1962179135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95020974) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 680694) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2022-05-21 |