| NPI | 1992972186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA Np95017803) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2026-06-24 |