| NPI | 1861992372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10032757) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9287512) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2025-03-10 |