| NPI | 1619417060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95005970) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95055588) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95005970) | |
| Enumeration Date | 2017-03-05 |
| Last Update Date | 2020-06-30 |