| NPI | 1790147270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95009672) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NP95009672) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-02-06 |