| NPI | 1821544974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95005248) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA F07161095) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2020-04-15 |