| NPI | 1932106697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 349032) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP30004493) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-22 |