| NPI | 1518722578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95029893) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95320396) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95029893) | |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-06-20 |