| NPI | 1215673918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95020764) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95020764) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2022-07-08 |