| NPI | 1740054469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 300237) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027011) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2024-02-04 |