| NPI | 1952964959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95011329) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011329) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-08-06 |