| NPI | 1699189522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95021143) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 207502) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-07-01 |