| NPI | 1639633084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95010787) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 351409) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 351409) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95010787) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2026-03-19 |