| NPI | 1063845832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 23521) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 801999) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2019-01-29 |