| NPI | 1982007787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 19832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 772668) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2024-02-06 |