| NPI | 1144816588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95016117) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95174477) |
| Enumeration Date | 2020-12-20 |
| Last Update Date | 2020-12-20 |