| NPI | 1881079283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002774) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 306197) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2024-06-17 |