| NPI | 1699296863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008659) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308217) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-08-11 |