| NPI | 1831587641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95001858) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: CA 95001858) |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2015-04-23 |