| NPI | 1376060319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95007202) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 818020) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2023-10-18 |