NPI | 1356851067 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 201904340NP-PP) |
Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WA 60767128) |
207Q00000X Family Medicine (Licence: WA AP60909309) | |
Enumeration Date | 2017-10-08 |
Last Update Date | 2022-11-09 |