| NPI | 1619533791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95018834) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA RN469260) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2021-10-28 |