| NPI | 1992405609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA NP95035430) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95035430) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2026-03-12 |