| NPI | 1447420252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95009188) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 210373) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2018-06-12 |