| NPI | 1033880901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 202113265NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201802224RN) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OR 201802224RN) | |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2023-06-02 |