| NPI | 1164939161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 95006164) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95108216) |
| 363L00000X Nurse Practitioner (Licence: CA 65006164) | |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2023-12-05 |