| NPI | 1346953361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 10009255) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 964403) |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-06-06 |