| NPI | 1134572423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95011470) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist Adult Health (Licence: NY 307843) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2024-06-26 |