| NPI | 1770856890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95022834) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006526) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2024-04-26 |