| NPI | 1780150698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF95029228) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX ap139359) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2025-04-29 |