| NPI | 1124834718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95036956) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95192219) |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2025-09-04 |