| NPI | 1255683140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NP95027617) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 005192) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201500803NP-PP) | |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2024-08-28 |