| NPI | 1972042331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95015905) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-77724-011) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2023-04-24 |