| NPI | 1891393732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95015437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95015437) |
| 363L00000X Nurse Practitioner (Licence: CA 95015437) | |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2024-09-11 |