| NPI | 1699823872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA NP 16595) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18655) |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2009-09-30 |