| NPI | 1508108457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95002318) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD R216186) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R216186) | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2022-08-30 |