| NPI | 1508358201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201905020NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP0000000) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2025-08-24 |