| NPI | 1699917138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95014074) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 31139) |
| 363L00000X Nurse Practitioner (Licence: NV 826830) | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2025-10-07 |