| NPI | 1730844838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202109761NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61241707) |
| 207R00000X Internal Medicine (Licence: OR 202109761NP) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-11-04 |