| NPI | 1457226714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95040750) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95281023) |
| Enumeration Date | 2025-10-07 |
| Last Update Date | 2026-08-07 |