| NPI | 1316377153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95002282) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5006628) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2017-04-17 |