| NPI | 1538783139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023363) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 23962) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A167770) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL TPAN1361) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 50537) | |
| Enumeration Date | 2020-05-31 |
| Last Update Date | 2026-06-12 |