| NPI | 1477149243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95023765) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95132895) |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2023-01-09 |