| NPI | 1225630197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95021196) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95201992) |
| Enumeration Date | 2020-11-14 |
| Last Update Date | 2024-01-26 |