| NPI | 1669454872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP 14943) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CA RN 508036) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2009-02-27 |