| NPI | 1386494334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95037444) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 335693) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2026-03-30 |