| NPI | 1700109527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 19065) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA NP 19065) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2023-04-24 |