| NPI | 1699434860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95018526) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: HI 4355) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2025-04-23 |