| NPI | 1992301063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95016185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 96016185) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2023-05-05 |