| NPI | 1548082886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95212921) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95032763) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |