| NPI | 1992338016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95028919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95098652) |
| 163W00000X Registered Nurse (Licence: SC 23710) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1116551) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 23710) | |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2025-05-27 |