| NPI | 1558836999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95009813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA NP95009813) |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2019-12-05 |