| NPI | 1285363887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95257285) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95035102) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-10-03 |