| NPI | 1841657798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 14164) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 45723) |
| Enumeration Date | 2016-01-23 |
| Last Update Date | 2020-01-07 |