| NPI | 1891142410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202101276NP-PP) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: NV APRN002179) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-09-17 |