| NPI | 1124905062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95036525) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95171145) |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2025-08-20 |