| NPI | 1235392689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-091621) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 13452) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: AL 1-091621) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2016-01-26 |