| NPI | 1386420594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95262978) |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2025-02-26 |