NPI | 1629786660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10000123) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10000123) |
Enumeration Date | 2022-11-08 |
Last Update Date | 2025-09-09 |