| NPI | 1609945138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN296539) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA FNP2794) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2025-09-11 |