| NPI | 1144686577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95003723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 835101) |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2016-06-30 |