| NPI | 1265917173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009733) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95099663) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2022-01-21 |