| NPI | 1346630662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95005802) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: GA RN175316) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN175316) | |
| Enumeration Date | 2015-01-24 |
| Last Update Date | 2024-02-21 |