| NPI | 1821584871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201905024NP-PP) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OR 201506812RN) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2026-07-21 |