NPI | 1821584871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201905024NP-PP) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OR 201506812RN) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-07-02 |
Last Update Date | 2021-01-26 |