| NPI | 1003162025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 9998) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 436601) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2012-07-27 |