| NPI | 1508916339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 088006487RN) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 088006487N1 FNP-PP) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2023-03-07 |