| NPI | 1063937902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009224) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 202101583NP-PP) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1081262) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-165613) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60783982) | |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2023-08-09 |