| NPI | 1104821032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP360218) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 360218) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-10-13 |