| NPI | 1538886890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95026128) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95326297) |
| 163W00000X Registered Nurse (Licence: MD R240115) | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2023-07-24 |