| NPI | 1629521646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95004279) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 841520) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2022-03-02 |