| NPI | 1770837791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201707674NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60798088) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02092) | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2018-03-17 |