| NPI | 1659883114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95007807) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95007807) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2025-12-24 |