| NPI | 1225305618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP21409) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 21409) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2024-10-25 |