| NPI | 1639201668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA RN328545) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NPF5219) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |