| NPI | 1487045621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 255442) |
| 163WE0003X Registered Nurse, Emergency (Licence: CA 614863) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 29618) | |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2024-03-18 |