| NPI | 1134804206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95020784) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: CA 729618) |
| Enumeration Date | 2023-06-16 |
| Last Update Date | 2023-06-16 |