| NPI | 1528618121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95034313) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP139837) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 907598) | |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2025-07-17 |