| NPI | 1811038755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201507396NP-PP) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC175336) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-04-16 |