| NPI | 1245337872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95020519) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA dc25160) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95020519) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2024-07-21 |