| NPI | 1316519341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95018161) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95203167) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2021-09-13 |