| NPI | 1912898545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95035997) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95035997) |
| Enumeration Date | 2025-07-11 |
| Last Update Date | 2025-10-06 |