| NPI | 1467130435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95032265) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CA 95157950) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-06-10 |