| NPI | 1790222958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95019206) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95063960) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2023-03-10 |