| NPI | 1376634998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 220980) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95001045) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-06-04 |