| NPI | 1457865388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201808187NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 5671037) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2025-12-13 |