| NPI | 1245739580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 2009395) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2023-12-07 |