| NPI | 1598792251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF8160) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA RN418863) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA17417) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2012-01-11 |