| NPI | 1336431154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 172841) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61140382) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 201250197NP) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2022-03-08 |