| NPI | 1447907555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025768) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9359625) |
| 163WI0500X Registered Nurse, Infusion Therapy (Licence: FL RN9359625) | |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2026-06-16 |