| NPI | 1962936930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013248) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: CA 610082) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2024-05-20 |