| NPI | 1982440228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 14712) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 553148) |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2024-07-05 |