| NPI | 1235297110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95003638) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN217839) |
| 163W00000X Registered Nurse (Licence: CA 768977) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2016-04-02 |