| NPI | 1275278996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202210480NP) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: OR 200541311RN) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2022-10-24 |