| NPI | 1558807024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95026004) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 95173882) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2024-08-19 |