| NPI | 1538617691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95005356) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 813630) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-12-16 |