| NPI | 1033783675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10017445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201609885RN) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-09-05 |