| NPI | 1730967266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95026487) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95026487) |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-03-06 |