| NPI | 1982342325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95023495) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95041252) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2023-02-14 |