| NPI | 1629514245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA 95005723) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95005723) |
| Enumeration Date | 2017-01-07 |
| Last Update Date | 2021-06-23 |