| NPI | 1528860236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10045841) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 202007390RN) |
| Enumeration Date | 2025-03-25 |
| Last Update Date | 2025-06-24 |