| NPI | 1801144472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201403166NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201403164RN) |
| 163W00000X Registered Nurse (Licence: WA RN00142133) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2017-02-09 |