| NPI | 1801604079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031332) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA NP95031332) |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-02-25 |