| NPI | 1568862522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001691) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 7325547-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 7325547-8900) | |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2021-11-30 |