| NPI | 1114003100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 087000130N1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 087000130N1 FNP-PP) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2012-10-12 |