| NPI | 1164252326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95031470) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 95266767) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2024-10-09 |