| NPI | 1275257669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 95022760) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022760) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |