| NPI | 1982747770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 16896) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP16896) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2021-12-20 |