| NPI | 1144960659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95019247) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: CA 95202441) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2022-03-31 |