| NPI | 1710442926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201900881NP-PP) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 201900881) |
| 207R00000X Internal Medicine (Licence: OR 201900881NP-PP) | |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2022-04-07 |