| NPI | 1497641732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95238727) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95035568) |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2026-01-28 |