| NPI | 1720537814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201707058NP-PP) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: OR 201707058NP-PP) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2023-11-21 |