| NPI | 1477091445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006131) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 539548) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2020-10-12 |