| NPI | 1124486568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI aprn-2076) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95003536) |
| Enumeration Date | 2016-01-30 |
| Last Update Date | 2016-03-21 |