| NPI | 1356039473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025472) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11009917) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2025-04-25 |