| NPI | 1740737725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201704061NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 114650) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-08-16 |