| NPI | 1275726960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200850129NP-PP) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OR 086006799RN) |
| Enumeration Date | 2007-08-25 |
| Last Update Date | 2015-08-26 |