| NPI | 1982750253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: CA RN247365) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA RN247365) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2011-12-21 |