| NPI | 1215322037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95009794) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL AG0215089) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-08-03 |