| NPI | 1609463710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 251497) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95153436) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2024-10-13 |