| NPI | 1689782831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP17701) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN711690) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA NP17701) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2019-12-18 |