| NPI | 1770843112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95018570) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 698955) |
| 363L00000X Nurse Practitioner (Licence: CA 95018570) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2024-01-12 |