| NPI | 1063842920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011767) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN104830) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA AP07021) | |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2020-03-09 |