| NPI | 1205207594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95017783) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2295490) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2022-01-20 |