| NPI | 1962559112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 087000017N1 FNP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA 60532967) |
| 363LF0000X Nurse Practitioner, Family (Licence: MT 102386) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 019896) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2021-05-24 |