| NPI | 1982356481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025697) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 348492) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2024-04-10 |