| NPI | 1609417021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013527) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 763301) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2020-07-02 |