| NPI | 1235897281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95024357) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95242868) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2026-07-28 |