| NPI | 1457853103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201801697NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201801697NP-PP) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2018-04-11 |