| NPI | 1568723674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95010636) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 811922) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2019-04-11 |