| NPI | 1639880271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023220) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1060665) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2025-06-17 |