| NPI | 1467917187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202208292NP-PP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 202208292-NP-PP) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2026-08-07 |