| NPI | 1205309580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 219336) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95011045) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2025-02-20 |