| NPI | 1720647225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95019322) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 25914) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2022-01-20 |