| NPI | 1003549437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95021639) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95283503) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2022-07-15 |