| NPI | 1417519844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 95013988) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 642388) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-03-19 |