| NPI | 1952733032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201600949NP-PP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 23358) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61354272) | |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2023-07-15 |