| NPI | 1538041264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95035946) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95173504) |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2026-05-18 |