| NPI | 1467989269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95006696) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95006696) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2018-07-10 |