| NPI | 1578927414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201808083NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 102193) |
| 363L00000X Nurse Practitioner (Licence: OR 201806384RN) | |
| 363L00000X Nurse Practitioner (Licence: WA RN60908911) | |
| 363L00000X Nurse Practitioner (Licence: WA AP60909960) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 102193) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2021-03-17 |