| NPI | 1366108698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95019020) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: CA 95140740) |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2022-08-16 |