| NPI | 1659815520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA R181805) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R181805) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R181805) | |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2026-06-04 |