| NPI | 1285396804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95018339) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 823434) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2025-11-03 |