| NPI | 1477958569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201705566NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001634) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2023-11-02 |