| NPI | 1275928756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95001788) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 814255) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA NP95001788) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2024-02-12 |