| NPI | 1457903239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201905384NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60975916) |
| 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-174725) | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2024-01-12 |