| NPI | 1346168192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95041335) |
| Additional Taxonomies | 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: CA 95293849) |
| Enumeration Date | 2026-07-08 |
| Last Update Date | 2026-10-04 |