| NPI | 1699915355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201508720NP-PP) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: OR 201508302RN) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN13781) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60203714) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2023-05-11 |