| NPI | 1205186509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201608201NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201242494RN) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2024-04-27 |