| NPI | 1174302350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95212940) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027407) |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2024-08-23 |