| NPI | 1639815392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10004265) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: OR 201805764RN) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2023-08-28 |