| NPI | 1295176394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008085) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 338595) |
| 163W00000X Registered Nurse (Licence: NY 658973-1) | |
| 163W00000X Registered Nurse (Licence: CA 95144813) | |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2020-11-11 |