| NPI | 1497050801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201150091NP) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: OR 201150091NP) |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2013-01-14 |