| NPI | 1083560015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95038919) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 95251946) |
| Enumeration Date | 2026-03-10 |
| Last Update Date | 2026-03-18 |