| NPI | 1093231789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95007625) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.021534) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-12-08 |