| NPI | 1407218936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95003783) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA 95003783) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2024-05-22 |