| NPI | 1205380060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95034566) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP53016) |
| 183500000X Pharmacist (Licence: CA RPH82668) | |
| 183500000X Pharmacist (Licence: NM RP00008566) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2025-11-11 |