| NPI | 1225593767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011188) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95121157) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2025-03-11 |