| NPI | 1598723918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201400385NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 12014) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-10-20 |