| NPI | 1578023917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010589) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 544459) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-03-21 |