| NPI | 1134620347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008526) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95008526) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2019-03-09 |