| NPI | 1639734478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 818354) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95011287) | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2024-06-13 |