| NPI | 1871565796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 9223) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF9223 RN643640) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-08-17 |