| NPI | 1417618729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95020376) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95068351) |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2026-05-22 |