| NPI | 1679690044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA RN351454) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NPF10167) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |