| NPI | 1912929936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 11492) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 564980) |
| 163WE0003X Registered Nurse, Emergency (Licence: OH 229706) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-04-12 |