| NPI | 1861861379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011203) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60598000) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-06-19 |