| NPI | 1003104423 |
|---|---|
| Former Name | DALE MICHAEL BUCEK TRUJILLO |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95009664) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009664) |
| 225100000X Physical Therapist (Licence: CA 18136) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2021-03-18 |