| NPI | 1982551925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95039015) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95262145) |
| Enumeration Date | 2026-03-10 |
| Last Update Date | 2026-03-16 |