| NPI | 1902262645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95003827) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 843493) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2020-10-07 |