| NPI | 1023784865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 64874) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95018056) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2024-10-30 |