| NPI | 1659835940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95014140) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95157758) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2021-04-16 |