| NPI | 1073569497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP 13934) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA RN262754) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2016-10-12 |