| NPI | 1477434199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95038811) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95326229) |
| Enumeration Date | 2025-09-09 |
| Last Update Date | 2026-07-01 |