| NPI | 1457021727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95019928) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI APRN02809) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2026-04-23 |