| NPI | 1730877432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025137) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95080477) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-07-03 |