| NPI | 1386195410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95012503) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9337649) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2024-08-21 |