| NPI | 1316558596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95018983) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ID 65063) |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 65063) | |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2022-10-06 |