| NPI | 1447920475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95015449) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 834848) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2026-04-26 |