| NPI | 1518243716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202002300NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP1110A) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2020-12-21 |