| NPI | 1497166961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001900) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: CA NPF95001900) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NPF95001900) | |
| Enumeration Date | 2014-05-18 |
| Last Update Date | 2019-04-18 |