| NPI | 1689391682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95063795) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95022810) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2024-02-07 |