| NPI | 1538517263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006321) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201607848NP-PP) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60720358) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000021215) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-03-07 |