| NPI | 1609498120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95014530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 95014530) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2023-12-08 |