| NPI | 1609200898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP23565) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN701069) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 23565) | |
| Enumeration Date | 2013-08-25 |
| Last Update Date | 2014-06-23 |