| NPI | 1144245358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP 8636) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN 484213) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-07-10 |