| NPI | 1013308485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001863) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 052216RAB) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2016-05-26 |