| NPI | 1790413920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022230) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 802458) |
| 363L00000X Nurse Practitioner (Licence: CA F07221391) | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2023-05-24 |