NPI | 1396053575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201805314NP-PP) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201805314NP-PP) |
363LF0000X Nurse Practitioner, Family (Licence: FL 9267450) | |
Enumeration Date | 2010-09-21 |
Last Update Date | 2022-10-12 |