| NPI | 1538545272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009050) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F339876) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2019-04-16 |