| NPI | 1619021466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 8465) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 461352) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-02-25 |