| NPI | 1588212906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201907643NP-PP) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 201907643NP-PP) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2023-10-03 |