| NPI | 1194255950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201902885NP-PP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 7702-33) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-10-13 |