| NPI | 1437715646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95019454) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A154369) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-03-16 |