| NPI | 1386035947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95002122) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002122) |
| 111N00000X Chiropractor (Licence: CA DC22853) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 870840) | |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2023-11-07 |