| NPI | 1891727699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 13312) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2027) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2025-08-05 |