| NPI | 1891337812 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95012821) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95012821) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95012821) | |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2019-10-10 |