| NPI | 1932690666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95038026) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 95030421) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2026-04-25 |