| NPI | 1255800850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 1201810185NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201810185NP-PP) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 201810185NP-PP) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2024-09-17 |