| NPI | 1689312100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95022427) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95180692) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2022-08-31 |