| NPI | 1982302998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95024059) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95024059) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95024059) | |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2026-08-29 |