| NPI | 1225165210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse Ambulatory Care (Licence: CA RN532879) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA NPF9545) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |