| NPI | 1104391200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023964) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95155507) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2023-03-30 |