| NPI | 1992285605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 843338) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1118851) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2025-04-16 |