| NPI | 1356430532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 13692) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 002744) |
| 163W00000X Registered Nurse (Licence: CT 065473) | |
| 163W00000X Registered Nurse (Licence: CA 594502) | |
| 163W00000X Registered Nurse (Licence: NY 525420-1) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2011-12-20 |