| NPI | 1992711063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA FNP7876) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA FNP7876) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |