| NPI | 1013465202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95004548) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95004548) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2024-08-28 |