| NPI | 1548894066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013935) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 12135482-8900) |
| 363L00000X Nurse Practitioner (Licence: CA NP95013935) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2023-12-14 |