| NPI | 1851884928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95009429) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 790711) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2019-11-21 |