| NPI | 1437837879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95128967) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-05-07 |