| NPI | 1831818533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95036464) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 350266) |
| 163W00000X Registered Nurse (Licence: NY 853793) | |
| 163W00000X Registered Nurse (Licence: CA 95413282) | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2026-04-16 |