| NPI | 1508536616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023531) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IN 28248728A) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-12-07 |