| NPI | 1235847625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023436) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 95208278) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2023-05-08 |