| NPI | 1396759916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200550156NP) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: OR 200040988RN) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-11-13 |