| NPI | 1235273749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95008930) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health (Licence: CA NP95008930) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2023-09-26 |