| NPI | 1376164210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP95014495) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95014495) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2023-08-02 |