| NPI | 1811911837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-826) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 17588) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2015-04-22 |