| NPI | 1205542834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95021116) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: CA 95021116) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2023-01-26 |