| NPI | 1346790706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004858) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95040295) |
| 207Q00000X Family Medicine (Licence: CA 95004858) | |
| 363L00000X Nurse Practitioner (Licence: WA AP60798120) | |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2023-05-01 |