| NPI | 1699456038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95030837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95116043) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2024-07-12 |