| NPI | 1952836769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95021972) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174744) |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2022-10-14 |