| NPI | 1780784488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 16861) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 506564) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-05-18 |