| NPI | 1235380080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 20139) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: CA 20139) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2023-07-27 |