| NPI | 1336698018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95029695) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ND R47370) |
| 363LF0000X Nurse Practitioner Family (Licence: MN 6838) | |
| 163W00000X Registered Nurse (Licence: GA RN204584) | |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN204584) | |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-07-16 |