| NPI | 1205251212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201500253NP-PP) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 201140205RN) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2018-12-27 |