| NPI | 1528609237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201908821NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201901581RN) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2025-08-27 |