| NPI | 1912047820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP4940) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA NP4940) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-04-10 |