| NPI | 1629639323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 202009231NP-PP) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OR 201341061RN) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2020-11-10 |