| NPI | 1295082584 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 22990) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 22444) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2018-08-08 |