| NPI | 1376507426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NPF14160) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF14160) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 397153) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2008-01-21 |