| NPI | 1154207454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95035684) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95035684) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95035684) | |
| Enumeration Date | 2025-08-12 |
| Last Update Date | 2025-08-25 |