| NPI | 1801520762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0200X Registered Nurse, Pediatrics (Licence: CA 95123510) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95034044) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-02-20 |