| NPI | 1841900479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95014288) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95014288) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-03-08 |