| NPI | 1982077632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: CA 95003260) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: CA 235758) |
| 163WX0003X Registered Nurse, Obstetric, Inpatient (Licence: CA 779079) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2015-11-10 |