| NPI | 1730964032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95026886) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 95026886) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-07-31 |