| NPI | 1528655438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95016714) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 752715) |
| Enumeration Date | 2020-12-26 |
| Last Update Date | 2023-12-13 |