| NPI | 1043597974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000400) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ ap3985) |
| Enumeration Date | 2011-11-06 |
| Last Update Date | 2014-03-11 |