| NPI | 1275277527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10041706) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70007887) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2025-09-25 |