| NPI | 1740862770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95013951) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN 28101) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2022-11-29 |