| NPI | 1306594478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95020350) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA F12210959) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2022-03-16 |