| NPI | 1588343784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95030967) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1126556) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2026-06-22 |