| NPI | 1770355851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10031846) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 1) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2024-10-23 |