| NPI | 1497418578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95029119) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 262151) |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2026-04-21 |