| NPI | 1205380060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP53016) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH82668) |
| 183500000X Pharmacist (Licence: NM RP00008566) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2025-02-07 |