| NPI | 1730559360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202008709NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 006253) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2023-01-18 |