| NPI | 1265803225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011551) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128865) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2019-10-09 |