| NPI | 1861992141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95009004) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: IL 20120540) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2019-11-19 |