| 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 |