| NPI | 1720135643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 200643114RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 562439) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 200750029NP) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |