| NPI | 1336318534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003854) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25499) |
| 163W00000X Registered Nurse (Licence: CA 797635) | |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2018-10-03 |