| NPI | 1649783176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10015829) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OR 200742518RN) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2023-10-12 |