| NPI | 1598572919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95034043) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 95240447) |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2025-02-19 |