| NPI | 1245097872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95028831) |
| Enumeration Date | 2024-02-29 |
| Last Update Date | 2024-03-09 |