| NPI | 1033661871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95003517) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95003517) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2018-04-05 |