| NPI | 1366917122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95165273) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 814886) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2025-08-12 |