| NPI | 1205435997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202213334NP-PP) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363LF0000X Nurse Practitioner, Family (Licence: WA API61363661) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2022-10-26 |