| NPI | 1528631470 |
|---|---|
| Former Name | JACOB MANN ROGERSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95025243) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1048231) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2025-05-06 |