| NPI | 1013572338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: HI APRN-3023) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0999661-NP) |
| 363L00000X Nurse Practitioner (Licence: OR 10026580) | |
| 363L00000X Nurse Practitioner (Licence: AZ TELE302862) | |
| 163W00000X Registered Nurse (Licence: HI 88197) | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2025-04-04 |