| NPI | 1134873656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95019395) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-5320) |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2025-08-15 |