| NPI | 1417383886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201501044NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60263557) |
| 163WE0003X Registered Nurse, Emergency (Licence: OR 098003053RN) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2021-09-22 |