| NPI | 1417754433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95034607) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 751125) |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2026-05-05 |