| NPI | 1285221440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95015009) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95015009) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2025-02-24 |