| NPI | 1538483995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 23570) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 688552) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 23570) | |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2020-01-09 |