| NPI | 1093110231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 10049638) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 299411) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2025-10-09 |