| NPI | 1063001444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031609) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 840497) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2025-05-23 |