| NPI | 1578008397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201706637NP-PP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201706637NP-PP) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2023-06-20 |