| NPI | 1790107670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 812590) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000284) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-03-10 |