| NPI | 1821461286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95019195) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95204519) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2024-03-06 |