| NPI | 1801284096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95001958) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001958) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2024-06-14 |