| NPI | 1922770874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95018267) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN95206146) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2022-10-04 |