| NPI | 1144390790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 9306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 218143) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2012-02-07 |