| NPI | 1255921177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 202010988np) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 202010988NP-PP) |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2023-12-14 |