| NPI | 1518295633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP95001118) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 609025) |
| 363L00000X Nurse Practitioner (Licence: CA NP95001118) | |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2014-11-03 |