| NPI | 1396493086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9428409-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95053192) |
| Enumeration Date | 2022-03-13 |
| Last Update Date | 2023-08-18 |