| NPI | 1093053449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201405804NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200341187-RN) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2021-12-29 |