| NPI | 1245778620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95008284) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95008284) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95008284) | |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2024-05-28 |