| NPI | 1497126197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95068057) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2020-10-22 |