| NPI | 1033738455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 10025666) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61077703) |
| 363L00000X Nurse Practitioner (Licence: TX AG030200045) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61077703) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2024-07-29 |