| NPI | 1407613920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA NP95028765) |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2025-01-07 |