| NPI | 1699857268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP12648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN532391) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2011-12-03 |