| NPI | 1932582558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95036152) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 559717) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2025-07-22 |