| NPI | 1326873019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031887) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95209777) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2025-09-26 |