| NPI | 1275960882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN740119) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95032547) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: CA RN740119) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2024-10-11 |