| NPI | 1619614922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95024133) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN306180) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-11-07 |