| NPI | 1295198851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95005717) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130346) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA NP95005717) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-08-15 |