| NPI | 1467600767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201050058NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 18301) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2013-03-28 |