| NPI | 1336411974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 21029) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 753418) |
| Enumeration Date | 2012-01-28 |
| Last Update Date | 2012-01-28 |