| NPI | 1669488151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200350074NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200141561RN) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2010-07-13 |