| NPI | 1386119188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95019522) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F345890) |
| 363L00000X Nurse Practitioner (Licence: TN 24889) | |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2026-03-10 |