| NPI | 1033827274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022585) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 778072) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2022-11-07 |