| NPI | 1164512240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013299) |
| Additional Taxonomies | 163WR0006X Registered Nurse Registered Nurse First Assistant (Licence: CA 519484) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-05-13 |