| NPI | 1629307533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050003NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 2001141562RN) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2010-02-11 |