| 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 |