| NPI | 1790013498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004566) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F335996) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2016-11-08 |