| NPI | 1275936908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95034186) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC13635) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2025-03-26 |