| NPI | 1417121633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 16422) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: CA 2685) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2008-04-18 |