| NPI | 1336971084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95030815) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95249462) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-09-19 |