| NPI | 1578220273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95029787) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95152258) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2024-08-29 |