| NPI | 1629303698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013151) |
| Additional Taxonomies | 104100000X Social Worker |
| 163W00000X Registered Nurse (Licence: CA 95122491) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2021-04-13 |