| NPI | 1346791852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95005040) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95005040) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95005040) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2019-07-30 |