| NPI | 1629345509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 20900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 20900) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2023-11-27 |