| NPI | 1487165817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009059) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI 47608) |
| 363LF0000X Nurse Practitioner, Family (Licence: RI APRN01705) | |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2018-10-19 |