| NPI | 1942634159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 23566) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 644612) |
| 163WW0000X Registered Nurse, Wound Care (Licence: CA NP-23566) | |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2021-06-15 |