| NPI | 1306198429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10041249) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 83016) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-5050) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95034292) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2025-03-14 |