| NPI | 1932392859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 085072588N1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 085072588N1) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2019-09-04 |