| NPI | 1437566619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002625) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 663435) |
| 163W00000X Registered Nurse (Licence: CA 95034102) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 339455) | |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2017-11-30 |