| NPI | 1265262752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95032046) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 742905) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-10-09 |