| NPI | 1932502440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95001996) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 51992) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2022-01-11 |