| NPI | 1710994058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201250206NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 75910) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2024-12-31 |