| NPI | 1497394753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95017019) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95190817) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2021-07-07 |