| NPI | 1063819191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI 1875) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001383) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2021-08-09 |