| NPI | 1225155690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA RN568106) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NPF13458) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |