| NPI | 1578766861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 200750068NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200740644RN) |
| 163W00000X Registered Nurse (Licence: TX 509631) | |
| 363L00000X Nurse Practitioner (Licence: TX 509631) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2016-09-02 |