| NPI | 1740684133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001440) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 846988) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2024-06-06 |