| NPI | 1780010595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002510) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019028369) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A161882) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277001251) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 62149) | |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2022-05-28 |