| NPI | 1740929967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025489) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95088376) |
| 163WE0003X Registered Nurse, Emergency (Licence: CA 95088376) | |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2023-06-14 |