| NPI | 1487302170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95024226) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5015923) |
| Enumeration Date | 2022-03-13 |
| Last Update Date | 2023-10-24 |