NPI | 1356834436 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202107861NP-PP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201709467RN) |
Enumeration Date | 2018-06-12 |
Last Update Date | 2021-11-18 |