| NPI | 1326687120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202004792NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 826511) |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2021-12-31 |