| NPI | 1528571130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61074323) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201708761RN) |
| 163W00000X Registered Nurse (Licence: ID 65076) | |
| 163W00000X Registered Nurse (Licence: WA RN60800461) | |
| 363L00000X Nurse Practitioner (Licence: OR 201709029NP-PP) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201709029NP-PP) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 65076) | |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2021-10-19 |