| NPI | 1386049310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95027736) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1025373) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201405521NP-PP) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2024-02-29 |