| NPI | 1972149052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: CA 708498) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013444) |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2019-12-13 |