| NPI | 1588260285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027236) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 00000000) |
| 163W00000X Registered Nurse (Licence: CA 95108577) | |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2026-05-11 |