| NPI | 1356705529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022710) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8939) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2026-05-27 |