| NPI | 1619584927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CA 95015908) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 11009410) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2021-02-12 |