| NPI | 1942073507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95027958) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95159855) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2023-12-15 |