| NPI | 1285254623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95026134) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-144879) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2023-10-25 |