| NPI | 1891412656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95022294) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95022294) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-01-10 |