| NPI | 1255841516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028616) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: HI APRN-2328) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2024-04-16 |