| NPI | 1437829058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95018377) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95026363) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2021-11-03 |