| NPI | 1750658662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95019867) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 202210765NP-PP) |
| 363L00000X Nurse Practitioner (Licence: WA AP61321680) | |
| 363L00000X Nurse Practitioner (Licence: GA RN227176) | |
| Enumeration Date | 2011-11-20 |
| Last Update Date | 2025-03-11 |