| NPI | 1487657029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA RN476192, NPF 8506) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA RN476192, NPF 8506) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2010-07-06 |