| NPI | 1578097598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN631073) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2024-11-24 |