| NPI | 1669921631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95016277) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95099043) |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2022-11-23 |