| NPI | 1447790043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010167) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704287221) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2019-07-17 |