| NPI | 1144084195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030103) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 10015736) |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-12-19 |