| NPI | 1699248716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011305) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 761150) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-03-12 |