| NPI | 1164660452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 18788) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 695844) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2015-01-21 |