| NPI | 1083059398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 23180) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CA 23180) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2024-03-05 |