| NPI | 1013320134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95000091) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95000091) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2016-06-08 |