| NPI | 1114495017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201810332NP-PP) |
| Additional Taxonomies | 163WW0000X Registered Nurse Wound Care (Licence: OR 201041424RN) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2022-02-22 |