| NPI | 1063523470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP12667) |
| Additional Taxonomies | 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA NP12667) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA NP12667) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-01-24 |