| NPI | 1396556239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95037145) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MI 4704400442) |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2026-06-08 |