| NPI | 1467903385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95013625) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 758854) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2020-08-31 |