| NPI | 1790201598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201707769NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60785555) |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 153353) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201707769NP-PP) | |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2020-02-17 |