| NPI | 1255688719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201602919NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209009708) |
| 367A00000X Advanced Practice Midwife (Licence: IL 209009702) | |
| 367A00000X Advanced Practice Midwife (Licence: OR 201602919NP-PP) | |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2020-10-14 |