| NPI | 1730723388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95021451) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 140818) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2023-03-07 |