| NPI | 1881070407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95004863) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 5007814) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2016-09-01 |