| NPI | 1043659147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 23534) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 696486) |
| 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA FNP 23534) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2022-10-19 |