| NPI | 1275171316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201904283NP-PP) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OR 201904282RN) |
| 363L00000X Nurse Practitioner (Licence: OR 201904283NP-PP) | |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2023-04-25 |