| NPI | 1912367814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 800956) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P31593) |
| 163W00000X Registered Nurse (Licence: CA 800956) | |
| 363L00000X Nurse Practitioner (Licence: CA 95020099) | |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2022-02-25 |