| NPI | 1780121582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006950) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: CA 86958) |
| 163W00000X Registered Nurse (Licence: CA 740595) | |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2021-11-02 |