| NPI | 1205269479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201391586NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200941299RN) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2015-03-03 |