| NPI | 1811073315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 200850057NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200841106RN) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2010-04-22 |