| NPI | 1407225147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP95002797) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 95002797) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2024-08-06 |