| NPI | 1366274516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95035630) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 37084) |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2025-08-11 |