| NPI | 1750984829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95031452) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95031452) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309770) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95034152) | |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2025-01-02 |