| NPI | 1265729628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201904712NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV MS001301) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2023-08-07 |