| NPI | 1356334221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 4964) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 13576) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2022-07-21 |