| NPI | 1578918348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201604409NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN128716) |
| 163W00000X Registered Nurse (Licence: OR 200743492RN) | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-11-03 |