| NPI | 1730515412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95015238) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2020-12-02 |