| NPI | 1700901543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013803) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23038) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-05-09 |