| NPI | 1730797523 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202213116NP-PP) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 305586) | 
| 363L00000X Nurse Practitioner (Licence: ID 1461172) | |
| 363L00000X Nurse Practitioner (Licence: NM 85485) | |
| 363L00000X Nurse Practitioner (Licence: NV 874007) | |
| 363L00000X Nurse Practitioner (Licence: UT 13742320-4405) | |
| 363L00000X Nurse Practitioner (Licence: WA AP61523641) | |
| Enumeration Date | 2020-07-17 | 
| Last Update Date | 2025-08-29 |