| NPI | 1609582287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10007749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10007749) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1099834) | |
| 163W00000X Registered Nurse (Licence: TX 805921) | |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2026-05-05 |