| NPI | 1154343077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 098006225N1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 098006225NIFNPPP) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-01-30 |