| NPI | 1851747166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95020584) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8654) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2024-03-11 |