| NPI | 1598406761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022402) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 853297) |
| Enumeration Date | 2022-04-04 |
| Last Update Date | 2025-02-11 |