| NPI | 1922502053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95025940) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002841) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-02-04 |