| NPI | 1528589777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 202358) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 823188) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95006484) | |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2332) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-02-06 |