| NPI | 1629471511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95001018) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001018) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 709361) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95001018) | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2025-12-30 |