| NPI | 1548997422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP95027233) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: PA SP025962) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-12-21 |