| NPI | 1457986952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95019261) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1050088) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2022-05-25 |