| NPI | 1780233916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012731) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-4810) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2025-04-24 |