| NPI | 1194230805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP95007795) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95007795) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2024-02-27 |