| NPI | 1063880524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002909) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95002909) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2024-12-04 |