| NPI | 1346624459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 3171495) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA 70109780) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201603114) | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2026-07-14 |