| NPI | 1003413055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95019937) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1015265) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2024-04-10 |