| NPI | 1043666092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95004298) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95004298) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2017-08-21 |