| NPI | 1437178191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 438668) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA FNP13130) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |