| NPI | 1003650466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95405892) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61209743) |
| 163W00000X Registered Nurse (Licence: CA 95405892) | |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2025-06-20 |