| NPI | 1245523489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 20516) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 665646) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2015-08-11 |