| NPI | 1346594165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95016427) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 259885) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2023-11-02 |