| NPI | 1548559925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95016495) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP011317) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2023-07-31 |