| NPI | 1235243007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95027074) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 091000510) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2024-04-19 |