| NPI | 1811994247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 200050029NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 200050029) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-11-18 |