| NPI | 1225547359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008046) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN219594) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2022-12-02 |