| NPI | 1568979417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95007349) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95007349) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95007349) | |
| Enumeration Date | 2018-01-01 |
| Last Update Date | 2020-01-15 |