| NPI | 1649826264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95011982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95011982) |
| Enumeration Date | 2019-08-11 |
| Last Update Date | 2022-09-02 |