| NPI | 1427600568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012513) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95079396) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2025-07-28 |