| NPI | 1063658763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 734142) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95016172) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2021-03-26 |