| NPI | 1154801280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011556) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ TRN216638) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2023-10-15 |