| NPI | 1154888667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011211) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95042336) |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2022-08-09 |