| NPI | 1255826962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95030857) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9301953) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2024-09-27 |