| NPI | 1699449587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95018051) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95166093) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2026-03-25 |