| NPI | 1427760982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95029002) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11022861) |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2025-02-07 |