| NPI | 1487033213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 95002281) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 95002281) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2023-10-18 |