| NPI | 1649685397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001908) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 521760) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 95001908) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2020-03-24 |