| NPI | 1841820834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95017132) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95193337) |
| Enumeration Date | 2020-01-19 |
| Last Update Date | 2021-05-25 |