| NPI | 1821361528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95011291) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 9921815-4405) |
| Enumeration Date | 2012-02-12 |
| Last Update Date | 2021-05-06 |