| NPI | 1548709660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95006115) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NV 844894) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2021-11-03 |