| NPI | 1154660066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 22358) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CA 3856) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2013-02-13 |