| NPI | 1215396395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95030939) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R199804) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9447760) | |
| 363L00000X Nurse Practitioner (Licence: DE LG-0001152) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R199804) | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2025-10-20 |