| NPI | 1316293467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 22389) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 822287) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 22389) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2014-03-17 |