| NPI | 1578235149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022289) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 770819) |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2022-10-06 |