| NPI | 1558114280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95029179) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CA 776031) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2024-04-11 |