| NPI | 1538431804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 20654) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: CA 707667) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |