| NPI | 1962924365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022806) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 95084770) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-01-26 |