| NPI | 1114408176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95009726) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95099023) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2018-08-27 |