| NPI | 1487611380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200550023NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200540385RN) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 200550022NP) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2018-09-26 |