| NPI | 1528664760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95017410) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1020679) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2021-10-11 |