| NPI | 1619911559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 200150081NP) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR 099007734RN) |
| 363L00000X Nurse Practitioner (Licence: WA AP30005962) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-05-14 |