| NPI | 1225605025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95024492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA NP95013688) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2023-06-14 |