| NPI | 1558674796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201809623NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 20341) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2022-07-27 |