| NPI | 1023316452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201609181NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 357654) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 21035) | |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2017-05-22 |