| NPI | 1811398365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001346) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ND R40976) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2020-03-26 |