| NPI | 1396799425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 777273) |
| 111N00000X Chiropractor (Licence: CA DC30043) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2018-04-17 |