| NPI | 1710452826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95010701) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 9453450) |
| 363L00000X Nurse Practitioner (Licence: CA 95010701) | |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2023-11-29 |